Introduction:
I am employed as a Healthcare Assistant at the Forever Young Nursing Home, which is a facility for the residential care of elderly or disabled people with approximately 30 full time residents.
I have undertaken an audit of risks identified throughout the working day, which I will outline in my report below;
Firstly, the Safety Health and Welfare at Work Act 2005 behoves the employer to;
– Provide training, information and supervision based on risk assessment, which should be delivered in a form, manner and where appropriate language that is reasonably like to be understood, and to
– Ensure Safe access and egress for all, which is particularly impertinent in the Nursing Home setting, due to the vast number of physically impaired patients.
Whilst the responsibility of the employee includes;
– Having regard to the training received and instruction given make correct use of any article or substance provided for use by the employee including personal protective equipment, with this requirement being of critical importance during the current Covid-19 pandemic and the acute threat it imposes on both staff and patients, and also;
– Co-operate with the employer as far as is necessary to enable the employer to comply with legislation.
Principles of Good House-keeping:
– Good housekeeping practices need to be an on-going process, with all staff and management involved to help control or eliminate hazards in the work-place, for example, bins being regularly emptied will reduce the risk of a fire.
– Housekeeping is more than cleanliness, it also includes general care, keeping work areas neat and tidy, maintain walkways and floors, keeping them free of slip and trip hazards.
– Maintenance of buildings, equipment and machinery should be constantly undertaken to ensure that they are kept in a safe and efficient working order and in good repair. It is vital that a good maintenance programme is adhered to in order to minimise incidents and allow good work practices.
– All staff should be regularly updated on Fire Safety Protocols. A nominated Fire Safety Officer should be on site at all times. Evacuation procedures should be demonstrated to staff as per national guidelines and the evacuation drill practiced as required.
– All staff to be given the appropriate Manual and People Handling training, updated as required by national guidelines. Applying the 5S in patient handling, i.e. sanitising shared equipment reduces the risk of cross contamination to the next patient and applying it to manual handling e.g. keeping items that are used most regularly closer reduces down the amount of manual handling.
– Flammable, combustible toxic and any other hazardous materials should be stored safely in approved containers within designated storage areas with access only available to authorised staff members.
– Regular maintenance checks to be conducted on items such as blood pressure cups, stethoscopes, mobility aids, lift slings as per manufacturers guidelines with any faults identified reported immediately as per reporting policies and procedures.
– Documentation including Material Safety Data Sheets should be provided for any chemicals used in the facility and all staff should be briefed on where these documents are stored. The Safety Statement should be read and understood by all staff members. Any staff member involved in food preparation and handling must have the required HACCP training and have a clear understanding of the procedures to be followed.
– Continuous staff training to be implemented as required and staff training records to be kept up to date and stored securely.
– Clear and definite Policies, Procedures and Guidelines to be set out and made available to all staff to provide instructions and guidance in response to specific circumstances. An example of which is the employee Code of Conduct policy document which must be adhered to at all times.
– National and International Guidelines to be implemented and adhered to by all staff, examples of which are; Document Ref: GD:06:24. RE: Interim Guidance for
Coronavirus. – Healthcare Worker issued by the HSE and the WHO Guidelines on the use of PPE in Healthcare and Homecare settings as well as during the handling of cargo.
– Staff required to engage as instructed with both internal and external auditing, reporting and monitoring systems as set out by management, including Safety and Quality Audits, Risk Assessments, as well as all audit and reporting requirements from the HSE and HIQA.
Risk Assessment
SAFETY & HEALTH @ WORK 5N1794
1
2
3
4
5
KEY:
L = LIKELIHOOD
S = SEVERITY
L X S = R
(RISK RATING)
SIGNIFICANCE OF THE RISK RATING
LOW RISK = RATING OF 1-6
MEDIUM RISK = RATING OF 7 – 12
HIGH RISK = RATING 13+
RISK RATINGS OUTLINED ARE BASED ON THE CONTROL MEASURES BEING IMPLEMENTED
Severity
Likelihood
No
Injury
Minor Injury
Lost time injury
Major Injury
Death
1
Unlikely
1
2
3
4
5
2
Possible
2
4
6
8
10
3
Probably
3
6
9
12
15
4
Likely
4
8
12
16
20
5.
Certain
5
10
15
20
25
No.
Hazard
Risk Of…
Likelihood
Severity
Risk
Rating
Control Measures
1.
Manual
Handling
Back Injury
3
2
6
People are bending incorrectly whilst bringing deliveries from the Reception area to other areas of the building. A trolley is to be made available to assist in the moving of these deliveries. This will minimise the risk of injury. Staff to be reminded of the guidelines of the Manual handling training they undertook.
2.
Patient
Handling
Neck and Back Injury
2
3
6
Strenuous lifting of patients can cause neck and back injuries. The mechanical lifting device is to be used at all times when lifting clients to prevent the risk of potential injury (all lifting aids to be serviced and maintained as per manufacturers guidelines).
When using slip sheets, 2 people are required to perform this task at all times. Signage to be put in place reminding staff of this.
3.
Slips,
Trips
Slipping on mat
Tripping over vacuum cleaner cable
4
2
3
3
12
6
Mat located outside the staff canteen area is unsecured. Anti-slip strips to be attached to the underside of mat to prevent it from slipping. Item flagged for corrective action.
Vacuum cleaner being plugged in and moved across the hallway is a potential trip hazard to staff, clients and visitors. A cordless vacuum cleaner would be a safer option and would eliminate this risk. Until such
Falls
Falling from step ladder in storage room
3
3
9
time as this is purchased, vacuum should be plugged in to the nearest point where vacuuming is taking place and a yellow warning sign placed in the vicinity.
Small step-ladder located in the store room is not fit for purpose. It is to be substituted with a safer step-ladder with wheels that lock in place and has handrails.
4.
Lack of
Personal
Protective
Equipment
Infection of oneself or infecting others
4
3
12
Surgical masks, aprons and gloves not being worn on all occasions by every staff member when they are in any client’s room or when there is physical contact between the staff member and the client. This needs to be addressed and rectified with immediate effect as it is a biological hazard to both staff and client.
All workstations to be provided with ample PPE supplies and new stock
checklist procedure to be put in place. The onus is also on staff members to flag any PPE shortages to their line manager.
5
Out of date burns gel in the
first aid kit in Kitchen
Ineffective in treating burns
5
2
10
All first aid kits in the building to be audited and restocked, with any expired products disposed of correctly.
A new First Aid Kit contents checklist to be generated. A designated person to carry out regular checks on all kits.
6
Poor Food
Handling
Habits
Food poisoning
4
4
16
Observed raw and cooked food on the same prep counter. This poses a high risk of a client contracting food poisoning such as Salmonella.
All raw and cooked food to be given separate sections of the prep area to prevent cross contaminated and staff to be reminded of the FSA and HACCP safety guidelines. Increased signage to be erected in food prep areas.
No.
Hazard
Risk Of…
Likelihood
Severity
Risk
Rating
Control Measures
7
Poor Hand
Hygiene
Practices
Imminent and severe risk of contracting or infection of Covid-19.
4
4
16
Observed staff member not washing hands after eating and returning to work-station. Significant risk at present due to the unprecedented infection rates/outbreaks of Covid-19, particularly in nursing homes.
All hand-sanitisers to be minimum of 70% alcohol content. Increased touch-point cleaning to be undertaken by contract cleaners. Staff to be given toolbox talk on the impertinence of practicing impeccable hand hygiene at all times. Additional signage to be erected throughout the facility.
Committee Report Introduction:
I am honoured to have been offered a full-time position with Forever Young Nursing Home having recently completed my probationary period. I have been invited to become a member of the Health and Safety Committee and I have recently conducted an audit of risks identified in the facility. The HSA provided training and outlined our roles and responsibilities under the Safety, Health & Welfare At Work Act 2005, which include keeping our building and grounds free from injury, danger and risk as well as promoting optimal mental, physical and social wellbeing, Herein are some of the main point I wish to bring to the attention of the Committee.
Summary & Findings:
Staff need to be reminded of the importance of T.I.L.E. (task, individual, layout and environment) while carrying out patient and manual handling duties. I identified some areas where this practice is not being applied and poses a potential risk of back injuries, namely;
Staff are bending incorrectly whilst bringing deliveries from Reception and are not using mechanical aids when moving/lifting patients.
Some un-safe practice have also been identified which could cause slips, trips and falls. Using the hierarchy of hazard control, elimination and substitution are the most effective means to minimise exposure to hazards.
I found a not fit for purpose ladder in the store-room which could cause a fall. By lowering the height of the shelves, the need for the ladder will be eliminated. Alternatively substitute the ladder with a new one with hand-rails.
Slip hazards were also identified, one of which needs urgent attention. The mat outside the staff canteen is unsecured and needs anti-slip strips attached to it.
A trip hazard was identified due to the long vacuum power cable when in use. To reduce down the risk, always use the nearest power point and use the warning triangle when vacuuming.
Staff are to be reminded of the training they received regarding the wearing of PPE. I observed 2 staff members speaking to one another in close proximity while leaving a patients room, neither of them was wearing a mask. Both the WHO and the HSE recommend that surgical masks must be worn by staff when providing care to patients, regardless of the Covid-19 status of the patient. Hand hygiene, social distancing and respiratory etiquette remain key in preventing Covid-19 transmission.
The First Aid Regulations 165, Provisions for First Aid, General Application Regulations 2007 include; “All occupational First Aiders equipment is to be adequate”.
The First Aid kits were checked and some out of date burns gel was found in the Kitchen First Aid kit which renders it ineffective and unsafe on a burn. I recommend the purchase of replacement burn gel.
Some very alarming breaches of FSA and HACCP safety procedures were also found in regards to poor food and poor hand hygiene practices. It is imperative that these guidelines are followed diligently. The two examples in my Risk Assessment identified raw and cooked food on the same prep counter and also a staff member not sanitising their hands after eating and returning to their work station. Both of these received a mark of 16 in the risk ratings of my Risk Assessment.
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Impact of Findings:
We have to ensure that we are continually up to date on the ever-changing Health and Safety legislation. Unfortunately, it is totally unacceptable to have a high-risk rating of 16 on 2 Risk Assessments. Failure to observe the correct procedures regarding poor food and hand hygiene practices poses an imminent and severe risk of contracting a bacterial infection such as
Salmonella or a virus such as Covid-19. These practices have to cease with immediate effect.
Two Risk Assessments had a risk rating of 12 which is classed as medium risk. This rating can be reduced if Good Housekeeping practices are followed and 5S principals are applied. A 10 and a 9 risk rating were also found and a series of low risk hazards which can be easily eliminated if the correct control measures are applied.
Course of Action:
There is some serious breaches to the Safety Health and Welfare Act 2005 and the General Application Regulations 2007. A review and overhaul of all work practices must be undertaken going forward. The 3 step approach of; 1. Identifying hazards, 2. Assessing the risk and 3. Putting control measures in place would manage the low and medium risk hazards. This measure must be documented and reviewed regularly.
By applying the 5S principals of 1. Sorting, 2. Segregating, 3. Sanitising, 4. Standardising, and 5. Sustaining will keep operations on the correct trajectory.
A new procedure needs to be implemented for creating a checklist for all of the First Aid boxes on site. A nominated person will be designated to carry out checks of the First aid kits regularly and flag any shortages or out of date items.
Additional Recommendations:
1. Toolbox Talks – this is a simple and quick way to get to the root cause of many issues.
2. Communication – By reporting broken items, near misses and accidents, corrective action can be taken, investigated if necessary and problems are resolved faster.
3. Safety Committee – excellent work being undertaken by the Safety Committee. This could be complimented by including a Safety Representative from every department and if meetings were scheduled to weekly instead of monthly.
4. Induction – the importance of induction training should not be under-estimated as it instils the importance of the high standards which are required by staff and it also ensures that regulatory compliance is understood and implemented in all areas.
5. Training – A new staff training programme to be created. Refresher courses and additional training can be sought from an outside consultancy firm, e.g. Barrow Training and Consultancy.
References:
Barrow Consultancy & Training – Rachel Kelly course content and notes https://www.hsa.ie– General Application Regulations 2007 https://www.hsa.ie– Safety, Health & Welfare at Work Act 2005 https://www.hse.ie- GD:06:24. RE: Interim Guidancefor Coronavirus. – Healthcare Worker
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